Worsening economic crisis in Sri Lanka: impacts on health
Authors: Anne Thushara Matthias, Saroj Jayasinghe
Journal: The Lancet Global Health (2022)

Just as the COVID-19 pandemic is receding in Sri Lanka, we are battling a fresh challenge: a health catastrophe stemming from economic and political crises. Threats to health from an economic crisis are multifold.1Hone T Mirelman AJ Rasella D et al.Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities.Lancet Glob Health. 2019; 7: e1575-e1583Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar Stress and lack of health care can increase cardiovascular morbidities. Malnutrition can affect generations of children. Communicable diseases can increase due to rising costs of amenities and the weakening of preventive and control measures. The accompanying political uncertainties, widespread protests, and social disruptions adversely affect mental health and worsen quality of life. These multiple crises have the potential to cripple health systems. At the time of writing, Sri Lanka announced it would be defaulting on its debts.2BBC NewsSri Lanka warns it will default on its foreign debt amid crisis.https://www.bbc.com/news/business-61076481Date: April 12, 2022Date accessed: April 14, 2022Google Scholar There is already a severe shortage of foreign exchange, leading to drug and device scarcities that have affected routine surgeries and clinical services. Lending organisations, such as the World Bank and International Monetary Fund, are negotiating relief packages and these could include cost-cutting measures and restricting the services provided by the tax-based health system. These strategies could adversely impact a health system that has an exceptional record of achievements, despite relatively low investments in health, providing all levels of care with no user charge. What can we do? At a macro level, health care professionals have already advocated for political changes, justice, and more transparent decision making that would help us overcome the economic crisis. A charter of the Professionals of Sri Lanka has been circulated, and many health-care professionals are participating in protests calling for change. First, and at a more specific level, actions including tapping into social networks and professional organisations overseas to obtain financial donations and drugs, consumables, and equipment must be taken. Second, cost-effectiveness of interventions will have to be a priority concern. A series of steps are proposed, as follows: more reliance on clinical judgment during clinical practice rather than laboratory investigations, development of appropriate cost-effective protocols for management, and prescribing of generic medicines that are cheaper.4WHO EuropeHealth systems financing. Impact of the financial crisis on health and health systems.https://www.euro.who.int/en/health-topics/Health-systems/health-systems-financing/activities/impact-of-the-financial-crisis-on-health-and-health-systemsDate accessed: April 12, 2022Google Scholar Third, establishing a stronger social protection system to help cope with escalating out-of-pocket expenses of households, impacts on productivity, and reduced earning capacity must be done. Social protection should be linked to the health sector and extended to cover newly emerging needs (eg, financial support for those affected by non-communicable diseases).5Jayasinghe S Illness and social protection: an agenda for action in Sri Lanka.Sri Lanka J Soc Sci. 2010; 33–34: 25-29Google Scholar There is ample evidence that health problems during an economic crisis can be mitigated by strong health and social protection systems.1Hone T Mirelman AJ Rasella D et al.Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalities.Lancet Glob Health. 2019; 7: e1575-e1583Summary Full Text Full Text PDF PubMed Scopus (89) Google Scholar Finally, improving efficiency by reorganising service delivery (eg, strengthening primary health-care services and an appropriate referral system) must be done. We declare no competing interests. Effect of economic recession and impact of health and social protection expenditures on adult mortality: a longitudinal analysis of 5565 Brazilian municipalitiesThe Brazilian recession contributed to increases in mortality. However, health and social protection expenditure seemed to mitigate detrimental health effects, especially among vulnerable populations. This evidence provides support for stronger health and social protection systems globally. Full-Text PDF Open Access